February 12, 2019

New Clinic Case Study - Roundtable Discussion with Matt Esrick, DPT and John Woolf, PT

PTO 38 | New Clinic


Matt Esrick, DPT is a "long-time listener" and reached out to me regarding some of the content of the podcast. Matt's a new clinic owner (less than a year) and, although he has an MBA, he still has some issues that he has to deal with - marketing, building relationships with physicians, and establishing himself in a crowded marketplace. John Woolf, PT has been a recent guest. When I told him about Matt's situation, he asked if we could talk to Matt about some of his issues and just push "record." I thought, "Great idea!" Here is the recording of our conversation. Matt was willing to share a little about his practice and the issues he's having, and was kind enough to listen to the advice and feedback we were willing to provide. My challenge to you, the listener, while listening, consider how you would coach Matt. As you scale, you will need to coach others - directors, VPs, supervisors, PTs. Start developing your coaching ears and consider what you would do/say to help someone in Matt's situation as if he was your employee.


Listen to the podcast here:

New Clinic Case Study - Roundtable Discussion with Matt Esrick, DPT and John Woolf, PT

I've got John Woolf and Matt Esrick here joining me in a first for the Physical Therapy Owners Club, and that is a little bit of a round table discussion. Matt reached out to me and shared some thoughts regarding the podcast. I had done a recent interview with John Woolf. I thought we’d put a few of you guys together and talk about the state of physical therapy and where Matt is in his practice. I'll let him share a story and maybe some of John's ideas on CSM. Matt, do you mind going first and telling us a little bit about your story, where you came from and what you're doing now as a PT?

I graduated from therapy school in 2016 after a career in consulting. That was successful but the economy wasn't at that time. We had a lot of negative business. We were on the darker side of things, whether it's axing jobs or trying to find cost-cutting approaches. I'm sick of it so I decided to just go back to PT school. I started working for a couple of doctors. I decided there was a better way to do PT. I decided to open my own practice. That started in September of this year. We finished our first quarter of business.

I reached out to Nathan after being a long-time listener of the podcast. I had some questions. I wanted to bounce some ideas and some opinions off of him and see what he said. That's how I got here. The actual backstory on our practice would be like a whole episode in itself because it's very convoluted. I know how to start a business. I've started businesses. It's one of those scenarios where a guy who has an MBA sit there and be like, "Why would you do practice in this scenario when you know better?" but you’re like, "I'm taking the ball and I'm going." That's what I did. We're growing but there's always those waxing waning moments of positivity and negativity as an owner.

Tell me a little bit about your practice. I'm assuming you’re an outpatient ortho. Tell me about your situation where you were at in New York, what those environments are like, why you chose that place where you're at and why you chose to do what you're doing.

We are outpatient ortho and vestibular. We're in Smithtown, New York. If you're familiar with the Long Island area, you already know we're all over caffeinated and generally angry most of the time, whether it's patient in pain or traffic. I work in a multidisciplinary office where we're all unaffiliated with each other. There's a physiatrist and a chiropractor in the same building. There was a medical marijuana weight loss guy, but he has since left. There's a men's health person. There's even an aesthetician. There's myself, the PT.

Did they invite you into the group or is this something that you founded?

That's where it gets convoluted. When I graduated, my first job out was working for the physiatrist and the doctor. We're going to start a PT practice together. That did not work out after talking to them because they weren't up to date on how physical therapy legally works, not that they were trying to do something illegal as much as they had an operational setup in mind that wouldn't work. I rectified that. I ended up working for the physiatrist for about a year. Like most doctors, I know and I'm related to, he’s a great doctor but terrible businessman. He wasn't our lead referral source for the entire year I worked for him, which is in a very irregular setup in a pop.

I kept staying on for a long time, working part-time in other places and stuff. I took a lead therapy role at other places part-time. At the end of March, he comes up to me and he's like, "I don't want to be in the PT business anymore." I'm like, "Okay." He's like, "Do you want to take over?" I'm like, "Sure. That's what I've been doing in a way. How quickly do you want to transition?” He was like, "How's two weeks?" I was like, "Are you serious?" He was very serious.

Literally April Fool's Day, 2018, it's over. It's not even two weeks. I'm like, "I’ve got to hustle to get all my paperwork in New York. I don't know how other states are but in New York to get a PLLC, it's supposed to take three months. It took until September, so you can't get an IRS number, which means you can't be in insurance as a group or anything like that until you have your PLLC. I'm in this awkward hold pattern where my finances are not in a happy place. We're still battling it out with certain insurance company registrations just like them closing that works and stuff. Now we're official as of September, but I've been at this technically since April. We're talking about volumes too, where I could have gone home for the next day and it wouldn't have mattered.

PTO 38 | New Clinic
New Clinic: As an owner, there's always those waxing and waning moments of positivity and negativity.


Now, I’ve got about 20 to 25 patients a week on average. I work a three-and-a-half-day week. It's one-on-one, which is a dinosaur in a lot of ways in the PT world, but I like being a zebra. It's simple equipment. There's a lot of technology in terms of the home side of things. There's manual therapy obviously. I enjoy it. I have a higher quality of life because of the way I practice. I wish our practice would grow faster because if you know anything about New York, it's very competitive. I can very literally throw a football to my three nearest competitors who are well established, whether they have pokes in with doctors or they're part of a hospital system or whatever it is.

I'm assuming you're trying to get in network with most practices. You are not trying to be a zebra in terms of going out of network or stuff. Are you trying to niche yourself in a certain way that separates yourself from the others?

At least on the insurance side, yes and no. One of your prior guests used a term I like which was like the insurances are on good behavior. I like that a lot because it's very funny because I agree there are definitely insurances that I have no interest in dealing with prior experience regardless of what they pay. I'm like, "This isn't worth the time." We do quite a bit about a network, believe it or not. We do a lot of cash, too, by coincidence. It's not something I've been pushing. At least in our area, I don't know what it is, the health plans. Some people's copays are $75. It's honestly higher than our cash rate or half-hour visits. I'm like, "Paying cash rate is easier." They're like, "Let's do that." It's unlike any office I've ever been in and I'm not saying that because I own it. It’s just the way we've been trying to run it and that's the way it happened in a lot of ways.

That's the way you want it, I assume?

As long as it's positive, yeah.

When you say positive, positive energy or positive cashflow, or both?

I consider those the same thing.

John, anything you wanted to ask about Matt?

Nathan, you had a podcast here with a young guy who is starting practice and you have an old guy who's already grown to practice. What happens is when you put people who are starting out together with people who've done it already, including yourself, there's some good conversation in there. It's almost like the old guy talking to the young guy. The first observation is you started this whole gig with an MBA under your belt already?

Whether you can or you can't, you're right. - Henry Ford Click To Tweet

Yes, MBA in Information Assurance, which is a fancy way of saying a difficult form of auditing.

You have a pretty good sense of numbers, changes in numbers.

I track 62 different metrics. Excel is something second nature to me, so that helps a lot. Our HEP app, because I've been working with as a beta tester for like three or four years now, that company unveiled a massive back-end data tracking system. It's based in Australia. It's their own version of MIPS in a way but specifically the exercise. If we do scale up, I'll have the ability to also go across different practitioners, different templated programs, different individual exercises and diagnose disease and filter them out. I’ll be like, "Maybe the exercises aren’t so good with this population anymore.” We narrow it down that way. That's been pretty cool to see you can almost run your own research. I don't have time for that at the moment, but it's something I'm looking into.

Doesn't every business owner run their own research?

I would agree with that, but I don't think in that context.

It certainly gets different. At the same time, how many guys and girls out there who are owners looking at their data to inform them of the decisions that they're making?

I would hope everyone is, but I don't think that's true.

I don't think so either.

I don't think so either. That's where I have to compliment you, Matt. You look at me, I didn't have an MBA. You definitely have a leg up on most people.

I didn't have an MBA either.

It took me I don't know how many years to figure out what my P&L was and my cashflow and stuff like that. You've got a leg up for sure. You're ahead of the game simply because you're tracking your stats. That's huge. A lot of guys don't do it.

PTO 38 | New Clinic
New Clinic: The ultimate success is the degree to which you can establish successful relationships.


My concern isn't the tracking of the stat. Like you've said before, for tons of other people in business and books say if it's not measurable, it's not getting fixed. If it's not getting fixed then you're more or less screwed. The data itself, if you don't know what to do with it, then I don't think it matters. I have a lot of data on growth, on our marketing strategies, and things like that. It doesn't help when I'm dealing with a front desk person when I go to a doctor's office for some direct marketing. There's no way I'm getting past that front desk. It doesn't matter what data I have. I could come in with gold bars, I'm not going to get to talk to that doctor. It's not going to happen.

Doctors don't want gold bars. Maybe the doctors do, but I don't think the people at the front desk want a gold bar. You're talking about something different. It's not the hard science of numbers and data, but it's now the interpersonal side, the relational side of what makes a business tick. There's a ton of research now about how the impact of not just the intelligent side of your business but the emotional side of your business. This little bit of my wheelhouse after all these years is the ultimate success is the degree to which you can establish successful relationships. What you said is spot on. It's a real common case study. It's like how is it that you get past that front office lady to talk to the doctor? By the way, does it matter? Is the doctor themselves making the referrals or is it someone else? Can we bump into this topic? Is this a good one?

That's fine with me. Do you want to go into that a little bit, Matt?

Matt, what do you think? Do you want to bump into this one?

I've been in scenarios where the doctor has nothing to do with the referral. I've also been in a scenario where I've sat for 30-something-minutes with a doctor thinking this is going to be a great relationship and got nothing out of it, which aggravates me. It makes me question my own skills. I'm a pretty good negotiator most of the time.

Were you in there to negotiate with the doc?

He proposed something I expected, which I don't have a problem with, which is a very soft version of one hand scratches the other. “If I'm going to send you patients, they're a hip surgery, I'd like my name to come up.” I'm like, "Your name will come up if your outcomes dictate that, and they do which is why I'm sitting in your office. If you weren't a good surgeon, I wouldn't be here." He liked that, but I still see nothing from him. I look at our marketing numbers for direct to doctor marketing. I'm like, "I don't know if this is all worth it at this point because they all still have hooks in with different hospitals and surgery centers to do these surgeries." I don't think the referral is coming from the doctor anymore. As a result, I'm looking at different avenues to do marketing. It's a quandary of sorts.

It is a quandary. It sounds like you stepped back to try to develop a strategy for it.

Definitely, I'm disgustingly organized.

That's a compliment. To be disgustingly organized means that's cool. You need the most help trying to figure out back to 33 versus 53. Nathan, you're older still. We're going to throw your age numbers into the story, too. We're going to combine our efforts to answer some questions. If one specific executable thing were better so that it would support your objective to grow your business, what would it be?

If it's not measurable, it's not getting fixed. If it's not getting fixed then you're more or less screwed. Click To Tweet

I know it sounds like a broad question even though I know it's not.

There's no right answer. Let's shoot from the hip and say, "If I could figure out that front office lady to get back there."

I would say the biggest thing I face right now is I need to boost our social element both in a marketing sense and an awareness sense. Get our name out there. On a personal level, I hate social media. I hate it. It's very unmotivating to do it when you hate it. I wrote to Nathan in the past, too. I'm like, "I want to know what someone says about ROI on social media because technically, social media is about building relationships. I've heard what you've said, John, about relationship-centered care and I was like, "That's genius," but how does that translate in a business sense to these things? How do you measure a relationship?

How do you measure it in the social space or how do you measure it specifically in a business space? They're slightly different.

I would argue business space at least in the sense that you have your marketing campaign for social in that context.

Social in the context of social media is very data-driven. In other words, those who are doing it well are watching numbers at an incredible level to determine what hits, what doesn't, the degree to what content people like about what. The big black box is what do people want to see other than cats playing the piano, which we already know works? What content or what information can someone give in order to drive the volume of exposures in your specific market? That's only one. The next part is the business side. To what degree does that translate in sales? To what degree does that translate into what would be a process of going to your clinic to say, "I want to go see that guy because he said something smart on the Facebook thing." I'm like, "I want some of that. I want some hands-on of that."

It sounds like you're talking about the conversion factor.

It exactly is a conversion factor.

What I was asking though is you gave the example on the last podcast with Nathan about the questions you ask when you're first doing an eval about their experience and their vision for getting better. When you talk about conversion factors and put it in that context, what are you looking at? I can measure engagement all day long on, Facebook and Google and all that. I can get that as a measure of business and how my marketing is doing. To me, that's not building a relationship because there are tons of research out there that suggests that the more involved in social media you are, the worse your actual relationships are because you've moved away from beyond what society operates into how we naturally would dictate a relationship.

That makes sense to me. The social thing serves to funnel people into a relationship with you beyond the initial engagement of a social platform. Back to the thing I talked about last time, let's say they walk into your office. That's ultimately what you want. If they do, then the presumption is that they’re going to pay you for some value. As a physical therapist, you have a tremendous value opportunity for them. The degree to which they understand and appreciate that value much depends upon a multitude of factors that you're going to present to them. Part of what you're going to present to them is the experience. These are the environment. I'm going to say because I'm hot on this idea, it's going to be the degree to which you connect with them, the degree to which you hear their story. One way to measure this is if they walk out and they say something like, "No one's ever listened to me like this." You will have hit it at least to the warning track, if not out of the park.

PTO 38 | New Clinic
New Clinic: Establishing relationships through social media is a big value that not many in healthcare and the degree to which your competitors are doing.


I've heard that and I agree with it. That's value right there.

It's a big value that not many other in healthcare are doing. The degree to which your competitors are doing it is going to be a differentiator.

How do you measure that value though that you established? It's a carry after the first visit. Are you saying it’s the fact that they're coming back?

Yes. You have an initial engagement and your first visit is a process of connection, diagnosis and treatment planning. The degree to which this is a successful process depends in part on how well you sell that treatment plan to that person. If you say, “You've got a thing. You've had now subacromial bursitis. It's common. You're 44 years old. You have a Type 1 acromion. It's not bad, but it's something. You have poor scapular control. This is how long it usually takes in my experience in order to improve scapular control in order to alleviate the mechanical pressure on this thing so that you can get that chemistry squared away and start feeling better and get back to playing with your kids.” “It's going to take that long?” “Yes, maybe not that long but what I want you to do is I want you to schedule this number of appointments.

Part of what we're doing is we're teaching you how to use your shoulder blade again. That's almost like going to a piano teacher. How long does it take to learn a song on the piano? It takes a while. It's not right away. It takes some practice. What you would normally do is you'd go to a piano teacher and they teach you some stuff. When you come back here in ICU, I'm going to be teaching you new things each time so that you can continue to improve how you use that thing. At the end of the day, you're going to feel a lot better and you're going to get back to doing what you love to do.”

If you can have those kinds of conversations right off the bat, you're going to kill it. That should be a typical pattern for any of your initial evaluations, whether they're coming into consult with you or not. If you have those types of conversations, you're going to be ultimately more successful not only in gaining their business but also retaining that patient so that they fulfill their plan of care. You're painting the picture, especially with their goals in mind because I'm sure during that conversation you're going to be talking about what their goals are. Do they want to play with their kids again? Do they play the piano? I'd like to go back to the question. I don't know if there's an answer to it. Matt, I know you brought it up to me and John, maybe you have some insight into it. You brought it up, Matt, in that there's a question out there as to what your ROI is on social media.

To make that jump from a social media engagement to get them in the clinic, that conversion rate to get them to step foot in the door, I don't know if people have a lot of data on that. The only thing close to anything that I've found was in my interview with David Straight from E-rehab. He highly recommended that if you're going to do Google reviews, it takes a tipping point of somewhere around 30 positive reviews for yourself to show up more on the search engines, to have greater SEO. That's the only thing I found. Sometimes I got this nagging feeling in the back of my head that no matter how much time we spend on Facebook, LinkedIn, Instagram, I wonder exactly how much conversion that's going to be. What do you guys think?

That's always been my thing because you want to go the avenues into both of what you heard and how you would accept a recommendation for therapy. I've never been going on Twitter and be like, "Who's a good therapist?" That's never happened. I don't think that's ever going to happen. At least I hope it doesn't happen. Going back to the ROI part, though, you can obviously measure conversion factors, but it doesn't tell you conversion cost of that conversion. That's where my concern is on the ROI.

I've built social media campaigns before and they've been successful. If you're going grassroots, you definitely have to suck it up and accept that it's going to be a slow loveless process. Eventually, you'll get there and then you do your pay-to-play marketing side of it and you'll get it. At the end of the day, I'm like, "Is this worth it?" I listen to a bunch of different podcasts, read tons of books on stuff like this. They're all like, "You got to get on social media." I'm like, "I feel like this is one of those hot topics where everyone says it," but in a service-based industry, I don't know if there is gain. I know a lot of people disagree with me on that, and I haven't done a lot of it for myself in PT.

I looked at everyone else's efforts and I'm like, "Unless you have a set policy in place where all of your employees are posting, where they're all engaging in this in line with the vision or in line with whatever outreach you're doing or whatever, how is this getting you profit?” It's the same question I see with a lot of people going to all these crazy manual therapy skills classes. I'm like, "Does this make you any more money? Does anyone know what this is?" I'm against specialties to some degree for that reason because no one's ever done a specialty on different OCS can get someone better, faster than I can.

It's very unmotivating to do something when you hate it. Click To Tweet

You're hitting on some deep topics. I'm going to do a deep dive on it a little bit. The first is like the social media thing. I'm going to context in this concept that people reach out to social media to connect. I had heard the statistic some time ago. I can't back it up right now. I don't know how accurate it is now, but the number one way people get information about their health is on Facebook. I shook my head at that too and I was like, “Could that possibly be?”

It explains a lot actually.

That's what I'm saying. It's like it says people make emotional decisions based on relationships that they trust and strangely people are stuck inside their phones out there connected and I've got my thoughts about it, but it's a certain truth. That's the level of relationship with people. I believe that engender some level of like, "I'm willing to try something." I believe that a certain amount of exposure to someone's nervous system about a concept. We see this in our current political atmosphere where people are being exposed to interesting messages.

Your brain starts getting into this thing. With regards to the degree to which it has an ROI, it has a lot to do with the cost of doing it. You're right. If your system is big enough, your sister runs a marketing firm and she can do all the social posting because she likes you and you're a good brother. You can get some regular content exposed in a fairly low-cost process. From that point, I would say that you could, anyone could, for that matter, begin to track data to determine the degree to which there's a certain number of likes.

By the way, social media is a process by which we’re communicating something, whereas in the past you'd have to go rent a billboard or something to announce a thing or take an ad out in the paper. You could have a 30-minute lecture in whatever organization you have or in your clinic about shoulder pain, the ten top reasons people have shoulder pain, and the three secrets to making sure that it goes away. It's that stuff that starts spinning people's nervous systems to want to start punching buttons and go, “I want that.” Clickbait simply for me is an appreciation for how the system works.

Back to it, I still think social is a process. It's a first level of expectation that people are able to form and help them decide if they want to engage with you like truly engaged with you. Right now, the continuum for engagement is pretty robust, which means you'd love to get them in the door, so they swipe their cards so that they pay you for the service. The other is now various forms of online advice, some of that webinar in shoulder pain in my area. If you like the idea, come on. It's going to cost you twenty minutes in the comfort of your house or wherever you want to do it. I do sense this, Matt. It's not unlike a lot of other people. If you don't dig doing it, if there's a part of you that's like, "I hate that." You're not Gary Vaynerchuk, the guy who absolutely loves throwing down and talking about wine or whatever else. Not all of us are built that way.

I like your point there, John. I didn't even think about that. If you're not into social media and even if you're not involved in social media yourself, it might be a waste of time because it's going to be something that you put on the back burner when it's something that you know you should be doing, "No, you shouldn't be doing it." It's on your to-do list. It's never urgent that you post something and put content on social media. Maybe you're better spent putting energy into things that you enjoy doing when it comes to marketing, niching, and branding out. Get creative in that realm instead of forcing a square peg into a round hole. If you're not the one that's on social media yourself, why waste your time trying it and trying to find the ROI?

That's why I asked about the ROI because it's a matter of dedicating the time that I could be spending on either something that has a higher ROI or something I enjoy.

Maybe it's more fun to figure out a way to get past that front desk person. Maybe it's more fun to niche down on a neat program that you want to put out to the community and send flyers to a certain postal code or something like that. I love that you brought that up there at the end, John. Maybe it's a waste of time if that's not in your wheelhouse.

I've talked to so many practice owners who are older than me. It’s like that classic, "I'm confused by technology and social media. I'm going to hire a young kid to do this for me," which ultimately usually is not a good idea. I feel like I'm like an old guy in that sense. I don't like video chat, to be entirely honest with you. It's one of those things. The first time I've video chatted with my wife. I was like the old guy that didn't hold the phone right. I was facing the TV. My point is that they don't seem to use it. Not that they don't use it well when they do, but they're fine. I look at that. You look at all other examples of what a successful practice is. Some of them don't use it at all. I'm like, "How do I get to that?" In this day and age, I feel like you do have to adapt to it, which is again why I keep asking about the ROI of it.

PTO 38 | New Clinic
New Clinic: Social media may be something that you put on the back burner when it's something that you know you should be doing.


Let's drill into that though. How do you get to what?

That successful practice that has almost no social presence.

What defines a successful practice? Let's say you had a steady pipeline of patients. There's a lot of other stuff you got to do well, but if you have a steady stream of customers in any business.

That means you have a solid revenue stream. I would argue a successful practice is accomplishing whatever initial vision and mission of the company was. Obviously, it should be profitable because otherwise, you're not going to be in business.

No margin, no mission. How close are you to achieving that?

We broke even in our first month, believe it or not, that's because our overhead is so low. I used to own a gym at one point, so sourcing equipment wasn't a problem. It was basically taking stuff out of my house. My wife got an extra room out of that, so that worked out well for her.

It sounds like you're on your way to achieving your purpose. What I'm hearing you say is that a successful practice is accomplishing the purpose of the owner?

It is, but it's also your own personal goals on top of that if you are the practice, like a scenario like mine. I have no desire to own multiple locations, at least right now. I do have an idea for scalability that I would like to do in the near future. There's also an exit strategy that was in place on day one. That's a whole other discussion. When you talk about like what are you looking to accomplish, I would like to make more money than I've made working as a staff PT as an owner. I'm not at that point yet, which is disappointing. I'm also not putting in as many hours to clinical work as I was. I stratify my own salary, to be honest with myself. Clinically, I make a certain amount. When I'm doing administrative stuff, I make another amount. Sometimes I don't even pay myself for marketing because I'm the one who benefits from this. This is insane. It's like paying yourself to drive yourself to your doctor. It doesn't make any sense.

Matt, what do you want?

In terms of the business?

The more involved you are in social media, the worse your actual relationships are because you've moved away from how society operates. Click To Tweet


I would like it to be completely self-sufficient. I've heard Nathan say it before and I take it to heart until recently. He used to live or die by the schedule that time. I definitely feel that on a regular basis. Some of that is ironing out how we schedule. Like you had mentioned, John, or at least if I understood what you said, it’s taking that relationship and basically converting it to the plan of care when it comes to the schedule. We block the schedule, but I don't fully do a full six weeks in one go. Some people think that's a huge error, but the reality is a lot of my patients won't do it. They won't. There's hesitation there.

There's hesitation there?

On their part or it's like, "I’ve got way too many things going on. I can't do that." I would say that's another classic definition of a sales objection.

They can't commit to getting better completely.

They can. They might schedule two to three weeks out. I've got to schedule six. Sometimes it's like, “I'm going on vacation.” I'm like, "Fine, whatever."

It's a lot of flexibility with that. Would you agree that success in our industry could be defined as a completed plan of care?

There's more to it than that. It's a completed plan of care, but it also depends on what your ultimate vision for the therapy you’re delivering.

Tell me more.

A few years ago, I heard Shirley Sahrmann said something along the lines of she would like to see PT the way we do dentistry in the sense that you're involved throughout the lifespan. I liked that idea. I've said it to patients before who I'm like, "You trust me when you're injured, but you don't even think about me when you're healthy." If you're going to trust me when you're injured, I should be the one, not your personal trainer, who's taking you through your wellness and fitness goals afterward.

PTO 38 | New Clinic
New Clinic: There is a matter of science of a plan of care.


Since spending time on our wellness plan, we've gotten a good number of conversions with that. It's the same argument though I see where they'll currently have a personal trainer still after getting hurt, paying the personal trainer X number of ridiculous dollars per hour session and they complain about their $20 copay. I'm like, "What is going on here? It doesn't even make sense.” When you asked me what my goal is or how I'm calling it success, I think having them for their lifespan in the context that they want. Like during rehab, I'll say it's a context we want to some degree because there is a matter of the science of a plan of care. In terms of wellness, it's up to them to some degree how they're defining their own wellness. I tried to do a good job of being honest with people and letting them be independent in their own decision-making. I don't like pushy salespeople so I try definitely not to be one. I try to not bias their opinions because I've seen it. We've all seen a placebo effect in sales or in treatment. Sometimes I'm being too much of a nice guy in that regard. I could drill down for what I need either financially or personally. There is a degree that we all share as PTs like a co-fulfillment where if they're satisfied, you get some satisfaction out of knowing that you provided that satisfaction.

It sounds like you listen to the podcast, but this is how you're built. This is a relationship-centered process. In other words, you're investing in that person. There's reciprocity. They care back enough so that you are combining efforts to get them where they need to go. Back to what Shirley Sahrmann says, we've built a profession based on an episodic process. It's an episode of care, but yet you're already saying, “I don't want this episode to end. I want this episode to end in the context of a pain or a disease process. I want this to stop, but yet I don't want to lose the relationship with you.”

I definitely want to make it clear that I don't support the concept of therapy forever.

It's not therapy forever but it is a resource available to them forever. That's a totally different thing. I still enjoy when patients email me or call me and said, "My shoulder hurts again. Do you have any thoughts on this?" I said, “Come back in. Let me take a look at. It's easy, really quick." They'll say, "Okay." We have 80 new customers into this organization every month. Start doing the math on 80 times 12. We have a bunch of clinics. Nathan knows what this feels like, but you can count the number of new customers you have every month and the degree to which you've established in one metric to measure this. The NPS is useful because it does truly give you some sense of loyalty to the brand and to who you are. Your ability to execute an NPS at some point in the plan of care is going to be important. I'm an advocate of getting clear on the front end, the very first visit.

I'm a big fan of asking specifically, "How was this for you?" That question is going to be responded to with the information. The information is going to come to you with some words, and you're going to get somebody language that’s going to communicate something, too. If and when you nailed it, and this is for any therapist and any practice, if you establish that therapeutic alliance upfront and they have truly this ability to connect with you, and there's some interesting research on that called attachment style, when that happens, the likelihood that they're coming back is very high.

Secondly, the likelihood that they're going to stick with a plan of care is very high. Lastly, the likelihood that they're going to call you first and/or recommend you to somebody else is very high. If we had to translate back to the very first part of our conversation about the emotional side, the soft science, not the data analytical side which I believe is important to support the emotional processes and the biopsychosocial processes, relationship-centered processes, that kind of stuff should be reflecting the success of your level of engagement, your ability to engage.

Let me credit you, Matt, because you're considering this where it is now. I think this is why you opened up your own practice. A lot of guys just want to get numbers in the door. We've all seen the mill grinding process. They get patients in and out and that kind of thing. If I'm not mistaken, you want to be a practice in which you developed a relationship such that your patients come back to you throughout the lifespan, based on what you said.

That's where I think the gold is for a lot of practitioners who want to fulfill their purpose as something more than revenue creators. The guys who want to fulfill a personal belief that they can do better in this life and affect their community and the patients' best is the people who engage in their patients and create that relationship. That's a credit to you. It's also a successfully run physical therapy practice that achieves your purpose, and that is to create those raving super fans. I talked about it in Neil Trickett’s podcast. It is where social media can help. It is where you can engage with those people who have already engaged with you and keep them abreast of what's going on in your clinics. It keeps your name in front of mind. Physical therapy, unfortunately, over the years has become a commodity. We've commoditized ourselves. When people say, “Physical therapy didn't help me,” then we did our patients wrong.

People reach out to social media to connect. Click To Tweet

Instead of saying, “Matt Esrick is my physical therapist.” I'll ask Matt what I should do about my musculoskeletal injuries. When you have that person, when you've won that person over, that's when you become successful. The fact that you're thinking about that now at the young stage in your practice puts you leaps ahead of other physical therapy owners because they might not be focusing on that. Retaining those patients and creating patients for life is where social media can help. Some email campaign newsletters can help to keep your name in front of mind. You don't want that person to go back and have a knee surgery two years later and not remember who the therapist was that did well for him two years ago for his back. You want them to tell the doctor, "Doctor, I don't even know where you want to send me, but I want to go Esrick Physical Therapy.”

That's nurturing a relationship. Nathan, you hit it right on the head. I'd say the same thing. You're already getting the important juice about this whole thing.

Matt, what are you doing nowadays to separate yourself from those other three clinics around you? How are you niching out? How are you branding?

I should probably start with the name of the practice, Honest Physical Therapy.

Nathan, how does that feel when you hear Honest Physical Therapy?

This area of New York has been described by multiple consultants as the least ethical place to do business. We've had some fun with our logo, too, in the sense that one of the doctors in our building from a distance said our logo which looks nothing like Abraham Lincoln. It looks like a silhouette of Abraham Lincoln. It’s like a little parody logo. We do some fun stuff on shirts and stress balls and things like that. To differentiate us, the first part is getting everyone to understand that it's one-on-one. There is no one-on-one on Long Island that's not home care. I can say that for a fact.

If somebody wants to come out and correct me, by all means to prove it. When I graduated from PT school, I went up to 47 interviews. I’ve got 40 job offers. I worked in close to twelve to thirteen different practices all over the place, an hour and a half away to fifteen minutes away. I'm very confident in saying no one does one-on-one, at least in an outpatient setting. No one does it like this because it's truly private. I don't have any aides. I don't have any assistants. I have a front desk person. She's great. That's it. If you're the first appointment in the morning, it’s going to be me waiting at the door for you.

That's a deep relationship. Is that built for longevity for you? In other words, is that your model going forward?

It is. That's part of our branding. We have rack cards and stuff. The three things that are on our rack cards are always progressive, always one-on-one and always evidence-based. Those are the three things I've pushed. Those are basically the three facets of the business. I've promoted multiple different slogans. Merit is what drives our business, not gimmicks or greed. The list goes on. I've put my whole marketing hat on and put a bunch of slogans and stuff. When you talk about differentiation, the first is one-on-one because nobody offers it. That's the core of our business.

The second is the simplicity of how we do things. If you don't have that equipment at home, we're not using. If you want to go out and buy some bands, I will teach you band exercises. Otherwise, I'm going to get creative. We've had cops who do the Emergency Services Unit tests, which is an insane test. They have to crawl through a 24-inch, 40-foot long tube, grab a 200-pound dummy and low crawl it out. I literally built the tube for this guy. I will get into it. If you want to be dedicated and do it, I will go far and much more than the extra mile for you.

Did you take some videos of that?

We did. We didn't get to release, though, unfortunately.

PTO 38 | New Clinic
New Clinic: When people say, "Physical therapy didn't help me," then we did our patients wrong.


That's gold on social media, you know that.

It could be. It's also, "Do I want to exploit my patients like that for my own gain?"

Can I answer that question because it might deserve a reframing? It's not exploiting the patient. It's exploiting the concept that physical therapists can be this kind of a servant, this kind of an expert at creating an environment to help you get better. I hear what you're saying, but I'm sensing it is possible you have some limiting beliefs about the degree to which you can reach people with the integrity that you're approaching this whole thing.

I definitely will not deny that I come in with a bias.

I hear that. To what degree is that bias helping you or hurting you?

I think sometimes it is. Other times, that's why I'm talking to guys like you. I need that second opinion to be like, "Wait a minute."

I'll get to help you click the switch on that one. In large part, beliefs oftentimes drive our behaviors in business and with patients. Part of our skills as clinicians for sure and sometimes as business coaches, consultants, whatever role we serve, is trying to ascertain the beliefs that hold and drive people's behaviors. When we start to understand what somebody believes about something, we have a better shot at trying to ask the right questions that help them to reflect more in a helpful way to determine the degree to which that belief is helping them or hurting them towards what they want to achieve.

I love Honest PT as a name. You can do so much with that and you can get creative to the point, I can imagine walking into your front office space and your fee schedule is there for everybody to see. You're not going to hide it.

Our fee schedule is on Google.

It's up front. I'm not surprised that's how you work.

I'll tell you, and this is where scalability and other business process, I get questions from patients who are like, "How does the bill work and stuff?” I'm like, "The standard visit is a half hour. I'm going to bill you two units. That's all there is to it. If your insurance pays more than our cash rate, fantastic. If it doesn't, we'll figure out what we need to do.” I also don't use modalities. That's one of our differentiating factors. I rarely used TENS, if ever. I don't have hot packs. I don't have ice packs. That's not skilled therapy, you can do that at home, at least that's my opinion on it. I do have some reservations about doing laser. The research on that is getting a lot stronger, so I'm coming around for that a little bit. Still, as part of while you're doing an exercise and for at least peripheral neuropathy, I'm a big fan of the neuromuscular stem.

People make emotional decisions based on relationships that they trust. Click To Tweet

Going back to what John was talking about in that you can definitely look at posting a video of your care in a couple of different lights. You said it's exploiting your patients, but I don't see it that way. I see that here's an opportunity to set yourself apart and be honest in how you treat. This is the social proof of how I treat and how we hold true to our values into our mission statement as a company. It is possible. It's a great idea to post some video like that like John said, simply because that sets you apart.

You can look up right now on Google and find a thousand different ways for physical therapists who posted their video about how to correct a shoulder or help shoulder pain. You post something like that where you're helping a New York policeman pass his test, there are not a lot of videos going around. That might help you stand out. Does that give you a bit more patients? I don't know, but it sets you apart more than anything. It can be cool social proof. John went down and did a dive into our limiting beliefs. Some of those things that might be holding you back, especially at this stage in your practice, you might want to be a little bit more open to doing things a little bit differently that are in line with your purpose in the name of your practice.

I have some definitive ideas for video. I should go back and change my wording a little bit when I said exploiting patients for my own gain. It's too strong of a word, but we're talking about relationships. I feel like you're taking that relationship and you're turning that person into an asset in the commodity sense rather than as a person.

Rather than exploit or commoditize the person who you're helping, I would flip that and say what you're doing is you're capturing the story of the situation to make sense. It's not the person. In fact, I would probably take great measures to keep the individual out of the story. There are a bunch of different risks right now that in HIPAA and a bunch of other things if you could stay away from, it would be ideal. Instead what you do is you use it as a case example and say, "I had a great opportunity to help a New York cop prepare for a very vigorous test. What was interesting about this is he had to do this. Can you imagine having to do that? Here's what we did. We created a thing. We did the thing. We pulled the thing around and next thing you know, this guy was killing it. It was a lot of fun. That's what we do here at Honesty.”

You've not leveraged the person. You've captured the story. It's the story that you're able to tell about your creativity in the context of helping people. People are like, "This guy gets creative and spends some time and thinks through it." That's a value proposition for many people. Oftentimes the experience elsewhere is that they're going through a cookie cutter process. It is unfortunate. It doesn't help our profession at all. It creates a tremendous opportunity for niche guys like you who are planning. You're in this to engage and spend the time, and that's it. You're going to get paid a certain amount, and that's what that's going to look like. However, you can be the best at doing that because you're telling compelling stories about how it is that you approach it, not necessarily what you do, but how you think about it. You could do that with every single case story that you come across.

It comes back to promoting yourself because, in comparison to the three other clinics around you, they've probably got pretty loud voices when it comes to marketing because they've been around a long time, whether that's because of word of mouth or their marketing engines and whatnot. If you limit yourself and keep a small voice, then you're not going to stand out like you want to. In order to promote, you've got to come with a loud voice that's specific to the people that you want to attract.

Matt, if that runs up until a belief barrier about self-promotion, one way to start to reframe that is what you're doing is promoting a mission. You're promoting something that you are promoting. You're speaking to the higher purpose of what you're doing. You're not out there saying, "It's me doing all these awesome things." It's, “What we've created here that affords our ability to serve people in this way.” Do you see the subtlety of the difference?

I like the reframing there.

That's exactly what it is, and sometimes by standing on that platform versus, "I’ve got to stand up and I've got to sound smart because this is about me." That doesn't work for me either. I know I might even get more traction by talking that way. The truth is I'm here to serve a purpose. I'm trying to help people in a way that's unique and interesting, "If I can help you with that, I'm happy to do it." That's a good reframe and it might be useful to stand on that and see what comes up.

PTO 38 | New Clinic
New Clinic: It's a great idea to post some video simply because that sets you apart.


I'm definitely going to try that.

You had a question or you wanted to bounce an idea because you had an opinion from somebody else, which is awesome and you wanted to get a sense of how two other old guys would reply to the idea. That's cool. Lay it on us.

I spoke with another business coach trying to get his feedback on the practice. We didn't get into numbers so much as much as I told him the situation I told you about how it started, where we're at now, and growth. The part that I also told him was essentially exit strategy that I started with. I have a partner in my practice. He's a minority owner. He has 30%. I have 70%. More or less a silent partner. He has his own practices on the east end. He's successful with that. He's a good friend of mine. He understands that I know the business very well. He was like, "Roll with it. Do what you want to do." I'm very happy that he supported me in that.

He knows that my wife and I want to move South preferably like a year or so after we have a kid, which we don't have yet. Hopefully, we'll have one soon. Everyone is like concluding. My father who was an entrepreneur was like, "Why are you starting a practice if you plan on leaving it?" I was like, "I like the concept of annuities where I can maintain ownership in something even if it's little and be far away. I grew it in the context I want to grow it in. I get it running the way I want to run it. Now somebody else can take that model, run the fit, and it's making me money past it. I liked that.”

The exit strategy was essentially to train someone else probably about a year out from when I plan on leaving to more or less fill my clinical role, even offer them a profit share to keep them interested in and be involved. At least in a one-on-one environment, if they don't have a profit share, they're probably not going to do the job to the best of their ability because their vested interest is significantly less. We were going to do that. Possibly flip flop our shares or rework our share so I'm no longer a majority. I'm a minority owner.

That was essentially the exit strategy once we reached the metrics we're looking to reach. Who knows, maybe someone will buy us up? You got the pro PTs of the tri-state area expanding to 100 practices in under a year or something. You never know what's going to come knocking on your door. Not that I would want to sell to them, but who knows when the situation happens, what's going to happen. The exit strategy was essentially that. When I spoke to this other business coach, I told him that. He's familiar with the New York environment and what it takes to be successful or highly competitive here.

He suggested I change my business model to more of a hybridized model, like a tiered system, which would involve a little bit of expansion, which I personally don't think we have enough volume to justify, and then bring in other staff. I was like, "I get why you'd want me to do that, but if I'm not at the growth stage that I want to be in, I don't know why I would choose to do it." Ultimately, after more discussion, I was like point blank, “What do you think my best move is here either in terms of marketing or overall to grow it?”

He flat out said, "You should close because you want to go down South anyway. Go work somewhere for a year, year and a half, however long it is, make as much money as you can to support that ideal environment because you started off and you've even said it. You started off in like the least ideal business relationship set up.” I get that there's that bias you go in with one of my favorite quotes from Will Rogers, "If you find yourself in a hole, stop digging." You could say I was in the hole when I started and I kept rolling with the punches. Now I'm out of said hole. I need to keep growing rather than go back in the hole. I was curious about what your opinions are on that. He only had a few facts about the business, but he flat out was like, “You should ax it.”

A successful practice is accomplishing the purpose of the owner. Click To Tweet

What's the temperature in New York?

It's four degrees. If you see me shaking throughout this, that's because our heat is not working.

I'm in Arizona. It was about 72. South, I don't know. Nathan is in Alaska. I know what he's doing up there. There are a lot of reasons to move South. You keep using the word growth because that's a big situation to dissect out. You're talking about growth and if I heard you, you're saying that if I have a certain amount of growth and I get to a certain growth point, then that's going to trip a number of other things. The whole rest of that exit strategy is fraught. It's fraught with a lot of assumptions that have to happen as a good Julian. They're not bad assumptions, but there are a number of important things that any success, I'll use generative business or successive business process, must have a totally different conversation. None of it can happen until you get a certain amount of growth. Growth is a process of determining you're here and you want to get here.

My sense is that you already know the difference, the gap between the two. You're running an evidence-supported, numbers-driven, data-supported business, you go, "I'm going to need this number of new patients, and this number of new patients statistically typically is going to net me this number of visits per new patient. Over a period of time, each new patient is going to get a referral of an additional new patient as a result of their efforts, etc.” This is an area regressive analysis type cool stuff if you're into that. If you're a spreadsheet guy, you should be doing this until Tuesday. The very first step is hunkered down. It's nice to ask these exit questions. Nathan would suggest every business owner do that. I totally agree with that. It seems as though the very next step is to figure out what would be necessary to get that growth. What's the gap? You've got a specific business model. That business model, I would say, does not lend itself to aggressive growth.

The reason that all of the chop shops are doing this volume business is because doing a volume business nets you a bigger margin. A bigger margin makes you a little bit more attractive to an investor or someone who wants to get into it because they're interested in the revenue and the margin that it’s going to produce. The real question is how do you take a niche business, a niche customer-centered and relationship-centered business like you're talking about, and find the right successor, someone who'd be willing to follow you, buy you out to some degree but leave you in it because you're still adding value, and have processes in place that they can follow to maintain the equity of your brand? What you're going to be leaning on at some point is brand equity. At this moment, the equity is you. People are leaning on you. The relationship is with you, not with the brand. If you move to Tucson or some other awesome warm place in the world, you're going to leave that place. Back to what Nathan was saying, you're going to want to go see Matt, but Matt is not there anymore.

Some of that though is the training and introduction because I've worked in practices that are larger where they have that issue.

Part of your investment is in the successor about how to transition those relationships. I'd have to say that you'd want a very robust process of measuring the degree to which you have a relationship with your patients, with your current customer base. To what degree do you have a relationship with your patients? If you have that, use that in a systematic way in order to improve the process of engaging these people, even with your successor.

That crossed my mind before. My partner does a lot of clinical instructing. That's in fact how we met. We thought about grooming a student probably in their third year at his clinic, and then transitioning them over to partner with me. They have that introduction. They get it on the system and we do it that way. The question is, will we have the business at a point where we can sustainably bring on a person who is essentially co-treating?

That's where you’re now, I would say, in the stage of execution of an idea of a plan gets a throw down on that because you can't even consider the next thing until you succeed in this first step.

You have to be successful in transitioning from a Matt Esrick centered clinic to an Honest PT reputation in your community. I'll follow up with John because I had one question come to mind as you were sharing your story, and maybe there's more to it. Why aren't you heading South right now and doing what you're doing? You and I both know that reimbursements are greater down South. You can pick off any place. New York has got the worst reimbursement. Why aren't you spending your time and energy down South creating what you're doing right now?

It's out of my hands in the sense that my wife is a New York City teacher. When she graduated, she had a scholarship where she had to work in New York State for five years or face the penalty fee that they ridiculously won't even prorate. We technically have the end of this year we could leave, but our families are both in New York. I don't want a newborn without its grandparents around for my own sanity.

That was my first question. My thoughts lean toward what John was saying. In order for the way you're set up, a lot of dominoes have to fall in the right direction at the right time to fulfill that. If you're going to do it, you've got to be intentional now with how you're building your practice, knowing your exit strategy ahead of time. You've got to make sure everything falls the right way. Kudos to you, first of all, for having an exit strategy. That's great.

PTO 38 | New Clinic
New Clinic: If you find yourself in a hole, stop digging.


Most guys don't and you need to no matter where you're at because all of us are going to exit at some time or other. The way you're doing it, the way you're set up, and the way you want to practice, a lot of dominoes got to fall in the right way. You've got to find the right guy that aligns with you, that agrees with how you're treating, that's willing to take on a partnership, and honestly to take on a little bit less revenue as a partner than you would partner up with another physical therapist with a different setup. Unless you're able to niche out, go out of network on a lot of stuff, go past cash-based, unless you change some things around, it's going to be hard to find that person. Still, to accept what your plan for succession is, a lot's going to happen.

I appreciate that sentiment. It is definitely a loaded situation. It's a lot better than exit strategy B, which is if we're not hitting the metrics. I have some regressions in place for what these metrics need to look like. We both decided like if at a year, we're consistently not hitting our metrics or we feel that getting the growth to the point where we're comfortable because sweating it out for like a year isn’t there, then give it the ax. Consider it proof of concept. It could work but in a different environment.

You can extrapolate some of your numbers to the average reimbursement of a different state and see if it works. You've done so well with your Excel stats. I'm sure you could punch in a higher reimbursement rate and see where your numbers are at that point. Do you know where you're looking to head down South mid-state?

It's still up in the air, possibly Texas, possibly Georgia. If she stops being a teacher, maybe Florida. Who knows?

There's no money in Florida.

I'm going to be the sole income of the household, but that's not going to happen.

You can be as an owner and you can do it. I know you can. With your focus, if you want to keep your wife at home taking care of your child, there's a way you can do it. Don't discount that. That can happen. There's a lot of value. What you're going through right now is a lot of learning processes. You're getting the numbers in place. You're getting your processes in place. You've formed your mission, vision, values, and purpose. You got an exit strategy. You know what you want to do in the next three to five years. There's a lot of power in that.

The important part is making sure that you are intentionally every week working towards the short-term goal that's going to get you here in the next six months, in the next year. If your head is down seeing patients 40 hours a week, then you're in trouble. You’ve got to make sure you're setting aside time for appropriate marketing to grow your business and all that stuff. You also need to have an eye down the road as the visionary for your company towards starting to develop relationships with colleges so that those students can start coming through your practice maybe on internships and stuff like that. Looking down the road, you've got to start doing some of these things to cultivate what you want at the end that forms an exit strategy.

We were planning different kinds of outreach. At one point, honestly, before I started the practice, I debated doing it as a nonprofit, which has its own gigantic can of worms unfortunately. It's good to hear all the different ideas that are out there to reinforce some things I had and some things that I didn't even think of. I appreciate that.

You could still do it nonprofit.

The gold is for a lot of practitioners who want to fulfill their purpose as something more than revenue creators. Click To Tweet

There's no benefit in the sense that loan forgiveness doesn't exist anymore.

I get it. It's very difficult. I'm still a subscriber. If there’s no margin, no mission. It's difficult to sustain the energy necessary. I'll keep coming back to what you expressed is that you're in it at a different level, you're just not swinging numbers. You're trying to be at some level, some pure essence of what a physical therapist can be. That's challenging in this environment. There are some ways to do it. It is going to require some absolutely hitting out of the park with relationship because those are the raving fans that you're going to need to sustain your business. You're going to have to be able to translate that and transition that to someone else. It's pretty powerful what you're trying to do.

You know your plan so well, Matt, of what you want to see and accomplish. From my previous episodes about getting a coach to essentially hold you accountable, if you let things slip, that dream and that exit strategy are going to slip further and further away, unless you're dedicated. I know I'm not.

It’s well-intended because you get the basics of it.

If you have a coach on board, you need someone to hold your feet to the fire if you're not good at that. A lot of us aren't. I don't know you that well, Matt, but that's where along the lines of my slogan, you got to reach out and find someone to hold you accountable and keep you on the path.

I've come to appreciate that more. I've told you before I was very much against the concept of coaches for a while. Maybe it's like the MBA and the business experience stuff because I'm like, "You're not going to tell me anything new for the most part." There are definitely things, which is why I have a partner partially for that. I will talk his ear off with ideas, see what he comes back with what's good and what's bad. He's been in the game for a while. I have come around with the coaches now. I got to thank you for that because I do like framing the mindset and changing the story. When you say things like they hold accountable, that totally changes it for me. I need that in a way. I'm my own worst enemy and best person for that at the same time, but it helps.

Take advantage of the network, the people that I've introduced you to on the episodes. You mentioned you liked what Michele Kehrer had to say on a previous episode. She sounds like she might be similar in practice to you simply on the vestibular side. There are opportunities to network with some of these people. They won't necessarily charge you, but if you want to pick their brain, I'm sure they'd be willing to talk to you on the phone for a few minutes or respond to an email if you have a question. Find ways to network. That's a great recommendation.

I know PPS has been doing their Peer2Peer NetWork. That's been relatively successful in the last few years. I saw an email that they're going to have some accountability groups or mastermind groups that are focused on cash-based businesses that might be a lot more along the lines of what you're doing, even though you're not all out of network. There are ways that you can get more ideas and maybe you'd get past some limiting beliefs. If a coach can hold you accountable, that's great. Those masterminds are pretty good at holding you accountable if they're working the mastermind correctly. They'll hold you accountable as a group. There are lots of opportunities out there to help you out to achieve your exit strategy. I don't want you to work it alone.

As you keep looking for a resource to help guide you through a process as we all need, there's a difference between a coach and a consultant. A consultant brings a lot of expertise, systems and knowledge. A good coach is going to help you grow and help you examine some beliefs that, once you reflect on them, you're going to say, "If I were to think about this differently, it would come to me and I'd be able to execute on it." Keep that in mind as you continue to seek this relationship. Both Nathan and I were there twenty years ago when we were trying to build our practices. There was always somebody in the mix who helped us through it, someone further down the road who can look back and say, "I've been there before. This is how it works." It saved my life more than once.

I have a question for you. I don't want to get into too much of the semantics, but I wanted to be clear about it. You keep using the word belief. I'm wondering why you're choosing that word belief because I wouldn't say my objections are using the belief barrier because the stuff I'm objecting to I have reason or support for. I'm not necessarily holding onto it tightly like you would have believed. I want to make sure I'm getting caught up in semantics or if there's a specific reason you use belief there.

PTO 38 | New Clinic
New Clinic: A lot of dominoes got to fall in the right way. You've got to find the right guy that aligns with you and that agrees with how you're treating.


I do use the word belief a lot in part because beliefs drive behaviors. Sometimes even as physical therapists, we’re trying to help somebody change a behavior such as a health behavior. We can try to change somebody's behavior by maybe teaching them something, making them more capable. However, it's not until you examined the reason or the belief or the value that they have for that behavior that it makes a difference. Oftentimes with patients, specifically when I teach this in courses, rather than try to change somebody's behavior by talking about behaviors, you do a better job of climbing a little bit higher in the meaning structure of how they organize in life, which is the belief.

What one believes is fairly predictable to what one will do. Oftentimes we may fail to execute on something because we're ambivalent about what we believe about it. We simply believe that social isn't that useful, so I'm not going to do it. It is, but if you can get somebody to help you restructure that and change its meaning, you might go, "I do believe in that. I didn't know I did." I think that's what good coaches are capable of doing. It’s reaching in a little bit deeper into how you structure the world and help you determine. Good coaches simply help you reflect on what's working and what's not. Accountability is useful, the personal trainer level of accountability, I would say. The physical therapist level of accountability could be one where it's a little bit more engaging, a little bit more transforming more so than, "Do this." That's how I'm trying to frame it.

I would say the same thing with the coaches that I've had in the past. The way where I thought they helped me out was questioning what I thought was true, giving me a different perspective on what I thought was real or reality and saying, "Maybe that is true. Is it possible that there's another perspective?" That's where a lot of value comes into play. That unlocked a lot of creativity for me to bring in some different thoughts and ideas that I didn't consider in the past. Not to say that my thoughts and ideas were wrong, but maybe there's a different reality to it, maybe there's a different perspective. When I did that, then that would change some of my actions, to go back to what John said.

This is great. If we helped, I hope that's awesome. For the audience, hopefully, if you have some of the same questions that Matt did, maybe we helped you guys out as well. John, I appreciate you sitting in on this. Matt, I appreciate you reaching out and sharing your thoughts and ideas about the podcast. Maybe we can do this again sometime, that would be great. Thanks for sharing and being willing and open, Matt, regarding your business and to John, for sharing your insight and taking the time out of your schedule to do this as well.

Matt, it's great meeting you. Seriously, you get some great things going on.

You too. Thank you both. I appreciate the time. I'll probably reach out to you, John.

John, do you want to do a little promotion here in what you're doing?

The relationship is with you, not with the brand. Click To Tweet

It's promotion but more, Nathan, back to what we've talked about even before we consider even doing this. It's fun for me and I think you said the same thing, to be able to talk to business owners who are on the path that we were fifteen, twenty years ago. It's absolutely fun to look back and say, "Back to the story, I had someone like that at some level give me some advice.” That's helpful to go, "Yeah." When we have an episode like this, this is as much of a case study in a relational process with Matt or whoever it is, it's always a good process.

I congratulate you in having a podcast and source in this way. I'm the guy with patient success systems. That means that I'm helping to coach and consult to help build relationship-centered care. What I've learned in this process, it's not about relationships with patients but it's a relationship with yourself, your relationship with your mission, and the degree to which you're able to serve in the way that you're called to serve. I'm saying it's a lot of fun to engage in this way.

How can people reach you, John?

At PatientSuccessSystems.com.

Matt, good luck with Honest PT. I wish you the best. I'm sure we'll stay in touch.


That was cool, John. I appreciate you bringing that up and inviting me to bring Matt on the podcast and discuss some of the questions that he had. How do you think it went?

I thought it went great. When you listen to the challenges that he's dealing with and the depth of questions and what's important about the next steps for him, we're all dealing with that at some level. For him to come out and talk about it and for us to give our slant on it from again, guys who are gray beards on this, I think he's on his way to figuring some things out.

I was impressed that Matt does have his stuff together in a couple of regards. He has an MBA so he has a leg up a little bit to begin with, but he's tracking his stats and he has an exit strategy. Those are two things that not a lot of us beginners start with. He still comes back to some similar issues that we all deal with in that we can learn as much as we want to about how to treat somebody. When it comes to interacting with doctors' offices and the desk person and how to work towards that exit strategy, those are things that you don't necessarily learn in any schooling even if you do have an MBA. It's valuable to have people like you on and other consultants as well to discuss some of those interactions that we still have to have on a regular basis.

It was a great opportunity. Thanks for having me on to do this. We should do it again.

If anyone out there is interested in reaching out to John directly to get some coaching/consulting, whatever it might be, he's available at PatientSuccessSystems.com. If you also want to be on the podcast or you have some ideas for me, as Matt did, feel free to reach out to me at Nathan@PTOClub.com.

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About Matt Esrick

PTO 38 | New ClinicMatt is essentially the driving force behind Honest Physical Therapy. He runs the show, treats patients, and is an avid devourer of the latest research. When he isn’t helping you in the clinic or vetting the latest evidence, he is usually hiking with his Aussie Cattle dog mixes (Ellie & Miles). Matt can also be often found on his surfboard, paddleboard, snowboard, or bouldering. A former competitive athlete, Matt played Division 1A Hockey and Rugby, and had an amateur boxing career, only to later hang up his gloves to become his wife’s latin dance partner. Because Matt has been lucky enough to travel most of the globe, he’s got some interesting tales of adventure.


About John Woolf

PTO 38 | New ClinicJohn Woolf is a physical therapist and athletic trainer. He studied physical therapy at Northern Arizona University and soon after completed a Masters degree in biomechanics and motor control at the University of Arizona. He was the Head Athletic Trainer and Director of Sports Medicine for the University of Arizona in the ’90s and then entered private practice at ProActive Physical Therapy in Tucson, AZ where he was the CEO of a 9-clinic organization.

In collaboration with a faculty based at Texas Tech University, he runs the International Academy of Orthopedic Medicine – US, a continuing education company that teaches physical therapists, and medical providers in the US, Europe and in South America.

With this group, he developed a course that explores the neuroscience and the general impact of the patient-provider relationship in the clinical outcome. He teaches this course to providers and health systems in the US.

He explores these topics with clients through coaching and consulting company, Patient Success Systems, that provides health care providers and organizations with systems and specific training to improve outcomes through patient-provider relationship training, change the language and relationship-centered care. He is currently completing a Ph.D. in performance psychology.

He has lectured as clinical faculty at the University of Arizona’s Surgical and Non-surgical Sports Medicine Fellowship Programs in the Department of Orthopedic Surgery and Family Medicine. He lectures for the University of Arizona’s Integrative Medicine Program and is on the clinical faculty in the AT STill University Orthopedic Physical Therapy Residency program.

He is proudly married to Chris and has two children, Natalie 22 who lives in LA and Timber 20 who is a freshman and Northern Arizona University.


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